Treatment of patients sustaining a complete spinal cord injury remains
an unsolved clinical problem because of the lack of spontaneous
regeneration of injured central axons. A 38-year-old man sustained
traumatic transection of the thoracic spinal cord at upper vertebral
level Th9. At 21 months after injury the patient presented symptoms of a
clinically complete spinal cord injury (American Spinal Injury
Association class A-ASIA A). One of the patient's olfactory bulbs was
removed and used to derive a culture containing olfactory ensheathing
cells and olfactory nerve fibroblasts. Following resection of the glial
scar the cultured cells were transplanted into the spinal cord stumps
above and below the injury, and the 8 mm gap bridged by 4 strips of
autologous sural nerve. The patient underwent an intense pre- and
post-operative neurorehabilitation program. No adverse effects were seen
at 19 months postoperatively, and unexpectedly, the removal of the
olfactory bulb did not lead to persistent unilateral anosmia. The
patient improved from ASIA A to ASIA C. There was improved trunk
stability, partial recovery of the voluntary movements of the lower
extremities, and an increase of the muscle mass in the left thigh, as
well as partial recovery of superficial and deep sensation. There was
also some indication of improved visceral sensation and improved
vascular autoregulation in the left lower limb. The pattern of recovery
suggests functional regeneration of both efferent and afferent
long-distance fibers. Imaging confirmed that the grafts had bridged the
left side of the spinal cord, where the majority of the nerve grafts
were implanted, and neurophysiological examinations confirmed the
restitution of the integrity of the corticospinal tracts and the
voluntary character of recorded muscle contractions. To our knowledge,
this is the first clinical indication of beneficial effects of
transplanted autologous bulbar cells.
I suspect that if you read the news you will have heard about this very exciting story. When we were at Queen Square Geoff Raisman was showing how you could use olfactory ensheathing cells (OEC) to get spinal injured rats walking. He has teamed up with some Polish surgeons to test these approaches in humans and today the results are published. Nerves generally do not regrow in the central nervous system, but to keep your sense of smell going you do actually make new nerves.
So in this study they took these cells from the olfactort bulb from the brain, this contains the olfacory ensheathing cells. These were cultured and then transplanted above and below the stab injury that caused the paralysis in this trial. They also took a piece of peripheral nerve and used this to bridge the gap between the two sides of the spinal cord. Many years ago I was in a Lab where we used pieces of muscle to act as a conduit to allow nerves to regrow through the muscle tubes to get sensation back to the feet of people with Leprosy. That was peripheral nerve and this is central nervous system, which is a whole dimension of extra difficulty. One person has done very well and is now a bit of a media star. He had intentsive physiotherapy and neurorebalitation, but the results are very encouraging.
Of course we will need to see this replicated and it is early days but this is definatively a move in the right direction.
On the down side I wonder how many quack sites will spring up offering OEC. However this is not a simple procedure.
Perhaps a cut is the best thing to try and heal first. As you know a sharp cut leaves a nice scar whereas a blunt damage does not. The challenge for MS is greater becuase you have an ongoing disease process and multiple sites of damage. However the fact that this approach was started many months after the injury leaves me with alot more optimism. However, this has involved a lot of hard work but the recipient and his rehabilitation has been ongoing for 2 years..so remember it may not be a quick fix, but that this work suggests that nerves can have plasticity.
I remember when Geoff was presenting his inaugural lecture at Queen Square and watching his injured rats climb ladders. I saw that his funding was largely from charities and not central government. It is through this support, that breakthroughs are possible and so keep up the good work...Research needs you!
It will be some time before this treatment becomes standard practice but a giant stride forward, so well done to all those involved notably the Polish Team.
For those of you in the UK and countries that get the BBC on television. More of this story (To Walk Again) will be presented tonight on Panorama on BBC Once (except Wales) at 22.35. In Wales you have to wait until 23.05